Organization
STOCKBRIDGE MUNSEE COMMUNITY
Active
Organization
STOCKBRIDGE MUNSEE COMMUNITY
Active
Other names
Stockbridge Munsee Health & Wellness Ctr
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WALLACE A. MILLER (TRIBAL CHAIRMAN)
(715) 793-4111
Entity
Organization
Contact information
Practice address
W12802 CTY RD A, BOWLER, WI 54416
(715) 793-4144
(715) 793-5028
Mailing address
P.O. BOX 70, W12802 CTY RD A, BOWLER, WI 54416
(715) 793-4144
(715) 793-5028
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32955900
—
WI
01
—
39114544+040
BLUE CROSS BLUE SHIELD
WI
05
—
41730300
—
WI
05
—
42125400
—
WI
05
—
44008700
—
WI
Enumeration date
08/15/2005
Last updated
03/25/2025
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